Under the law, you have the
right to give instructions about your own health care. You also
have the right to name someone else to make health care decisions for
you. These forms let you do either or both of these things. They
also let you express your wishes regarding the designation of your primary
physician. If you use one of these forms, you may complete or
modify all or any part of it. You are free to use a different
form.

The first (longer) form also lets you express
your wishes regarding organ donations, the designation of your health
care provider and information about your spiritual advisors. If
you use this form, you may complete or modify all or any part of it. Once
again, you are free to use a different form. The
second (short) form is intended for individuals who have limited
instructions or who are in a hurry or who may have difficulty with the
long form.

If you make a new advance health care directive you should locate any
old ones and replace them. It is a good practice to safeguard the
original and keep it with your other important papers. Let people
know where you keep this important document and how they can get it in
an emergency.

It is also a good idea to perform the Advanced Directive Checklist to
ensure that you have completted all the necessary elements of a good
Advanced Directive for Health Care. You may view this checklist online
by clicking here, or download
the complete Informational Brochure by following the links at the left
of this window.

Long Form

Part 1 of this form is a power
of attorney for health care. Part 1 lets you name another individual as agent
to make health care decisions for you if you become incapable of making
your own decisions or if you want someone else to make those decisions
for you now even though you are still capable. You may name an
alternate agent to act for you if your first choice is not willing, able,
or reasonably available to make decisions for you. Unless related
to you, your agent may not be an owner, operator, or employee of a residential
long-term health care institution at which you are receiving care. Unless
the form you sign limits the authority of your agent, your agent may
make all health care decisions for you. This form has a place
for you to limit the authority of your agent. You need not limit
the authority of your agent if you wish to rely on your agent for all
health care decisions that may have to be made. If you choose
not to limit the authority of your agent, your agent will have the
right to:

(a) Consent or refuse consent to any care, treatment, service, or procedure
to maintain, diagnose, or otherwise affect a physical or mental condition;

(b) Select or discharge health care providers and institutions;

(c) Approve or disapprove diagnostic tests, surgical procedures, programs
of medication, and orders not to resuscitate; and

(d) Direct the provision, withholding, or withdrawal of artificial nutrition
and hydration and all other forms of health care.

Part 2 of this long form lets you give specific instructions about
any aspect of your health care. Choices are provided for you to express
your wishes regarding the provision, withholding, or withdrawal of treatment
to keep you alive, including the provision of artificial nutrition and
hydration, as well as the provision of pain relief. You may
also add provisions relating to mental illness. Space is provided for
you to add to the choices you have made or for you to write in any
additional wishes.

Part 3 of this long form gives you options relating to the disposition
of your organs/ body.

Part 4 lets you designate a physician/facility
to have primary responsibility for your health care.

Part 5 pertains
to religious or spiritual information you may wish to provide.

After completing either the long or short form, sign and date it at
the end and have it witnessed by one of the two alternative methods
indicated. Give a copy of the signed and completed form to your
physician, to any other health care providers you may have, to any
health care institution at which you are receiving care, and to any
health care agents you have named. You have the right to revoke
or replace this document at any time.

The short
form may be used if you do not desire to complete the long form.
It does not provide the detail found in the long form and may not address
all your needs.

Part 1 of this form
is a simplified power of attorney for health care. Part 1 lets
you name another individual as agent to make health-care decisions
for you if you become incapable of making your own decisions or if
you want someone else to make those decisions for you now even though
you are still capable. You may name an alternate agent to act
for you if your first choice is not willing, able, or reasonably available
to make decisions for you. Unless related to you, your agent may not
be an owner, operator, or employee of a health-care institution where
you are receiving care.

Part 2 of this
form provides basic options for instructions about your health care. Choices
are provided for you to express your wishes regarding the provision,
withholding, or withdrawal of treatment to keep you alive, including
the provision of artificial nutrition and hydration, as well as the
provision of pain relief medication. Limited space is provided
for you to add to the choices you have made or for you to write out
any additional wishes.

After completing either the long or short form, sign and date it at
the end and have it witnessed by one of the two alternative methods
indicated. Give
a copy of the signed and completed form to your physician, to any other
health care providers you may have, to any health care institution
at which you are receiving care, and to any health care agents you
have named. You
have the right to revoke or replace this document at any time.